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PtRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P/t )Li✓ / J <br />SITE ADDRESS <br />� cl: 2.0j- <br />PARCEL TAX I.D. # P RpAIT # <br />o , S —3 ►ols� goo � ��%9 <br />LEGAL LOT NO. <br />DESC. <br />BLOCK <br />[— <br />TRACT fn� AID <br />LA1uV (, 1s1 /-i V r' <br />OWNER ADDRESS CITY/ZIP PHONE <br />111��\��: �5. i I�r S ,3'1ZZ �?"1'tl Avg �• E.�cGL I ` `2�� 4b-3"0-73C,0 <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />J l l fQU�� yZ5 210 -Z14 2-`I <br />CONTRACTOR ADDRESS CITY/ZIP PHONE <br />HAPtCk U:w5' Vi�rtiiLS 7 tZ2 L A,,i Fv't E�tiRE"1 T �25 3�11'13b1� <br />CONTR. LICENSE # <br />NtAAc k l5'IG 1 2-17 Z u2L'S <br />USE OF BUILDING <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />n <br />5 C� <br />_Electric Gas _Other <br />— 2 <br />WORK DESCRIPTION <br />r <br />I�CC/ 2221 <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />A/C — air ha,niling units <br />Z <br />Bathtub / <br />7—Forced <br />air systems <br />q <br />Lavatory (wash basin) " <br />Gas piping <br />Shower <br />L <br />Water heater <br />J <br />Kitchen sink 8 disposal - <br />Gas fireplace <br />Dishwasher <br />L <br />Gas range <br />Clothes washer <br />Clothes dryer <br />�- <br />Water healer <br />I <br />Range hood <br />_ <br />Sink (service/bar/mop/etc.) <br />/ <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />Urinal <br />Unit heater <br />_ <br />_ <br />Drinking Fountain <br />_ <br />Boiler <br />Floor drain <br />_ _ <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />Woodstove <br />_ <br />Roof drains <br />Other _ <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the pedc•.;lance of <br />construction. That I am authorize` by the owner of this property to perform the work for which application is made :rid I comply with the <br />Statd ontracld Law 1 27 RC d 296.200 WAC. <br />( <br />�� t _ k <br />� �KJ <br />Signa ure o u\ ont a to uth ized Agent Date <br />